7 Ways Obamacare Is Working
Jonathon Cohn at New Republic assesses Obamacare's first year, rounding up the various reports and surveys of the law to determine that, however unpopular it might still be, it's performing remarkably well. The bottom line for the law was whether it reduced the number of uninsured people in the country, and did it affordably. Those were the primary goals, along with "bending the cost curve"—cutting into the sharp growth in healthcare spending. Since the law was fully implemented, with enrollments starting last October and all the other provisions rolling out on January 1, there's been real progress in all of those goals.
First and foremost, it's indisputable now that more people have insurance.
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The most complete data comes from a series of surveys from independent research organizations—the Commonwealth Fund, Gallup, the Rand Corporation, and the Urban Institute. Their numbers do not match up precisely, but all of them have found that, as a result of the law’s coverage expansion, the number of people without insurance fell by something like 10 to 12 million, once you add in the young adult who got coverage because of the law's under-26 provision. Meanwhile, hospitals are reporting that they are seeing fewer and fewer uninsured patients.
That, by the way, is good news for hospitals because they're saving money. But for the people who now have insurance, two studies suggest that their lives have improved. The Oregon Medicaid study and a Massachusetts study both show that the newly insured have greater economic security and report better mental health. In Massachusetts, they found that physical health improved, as well.
It is also turning out to be pretty darned affordable, as far as health insurance goes. A Kaiser Family Foundation survey found that among the people who switched into an Obamacare plan—about 40 percent of the new enrollees—46 percent said they were paying less for their new plan. Premiums for 2015 are shaping up to have very modest increases and even in some markets, decreases. That's in part because of increasing competition: more insurers are jumping into the Obamacare market. The existing, employer-based market is showing very reasonable premium hikes, as well.
That all contributes to what's most surprising: health spending in the country is rising, yes, but rising at historically slow rates. The cost curve is indeed bending, from a variety of factors. Part of it is the recession, but "most experts now think the 'new normal' is lower inflation, because the healthcare industry is becoming more efficient—at least partly in reaction to new incentives that the Affordable Care Act introduced." One of the key things that means, undercutting years of Republican talking points against the law—is that the net effect of the law on the budget is a reduced deficit.
Much of the very good news of Obamacare boils down to Medicaid expansion—even though it hasn't been expanded in two dozen states. That's true for the improved health of the recipients, but also the significant savings for hospitals, savings which ripple through the system. Imagine the impact national Medicaid expansion could have.
